ClickCare Café

Is Medical Training About Rigor… or Bullying?

Posted by Lawrence Kerr on Wed, Jun 20, 2018 @ 06:00 AM

matteo-vistocco-424475-unsplashI played college football at a Division III school. That means there were no scholarships or cheerleaders, and high levels of academic work were requisite to playing on the team.

But the rigors of the team — sprints and pulling heavy objects up a dusty hill and doing two practices a day in the heat of late summer — were intense and real. Our coach was certainly not always polite, and part of the reason he was able to extract such hard work from us was that we were scared of him. There was a lot of shouting, quite a bit of belittlement, and frequent exertion past the point of exhaustion.

But I, like most of my fellow players, look back on that time with the fondest of feelings. It was a time when I knew I was getting the most out of myself, getting out of my own way, and contributing to something bigger than myself.

In a similar way, I look back on my medical training — as taxing and exhausting as it was — with fondness and respect. So I was interested to read an article in the New York Times characterizing much of medical training as bullying and harassing.

A recent New York Times article, by Dr. Mikkael A. Sekeres, M.D., looked at whether the US medical training system, especially for doctors, is marked by bullying, belittlement, and harassment. He cites a study that surveyed 1,387 American medical students in their final year of school finding that 42 percent reported having experienced harassment and 84 percent experienced belittlement during medical school. And he shares his experiences in medical school and residency, with doctors pulling rank, obsessing about his perceived faults, expecting inhuman work hours, and unattainable ideals of precision. In other words: he had normal training for a doctor.

Dr. Sekeres’s experience didn’t surprise me, of course, and indeed makes me remember many of my own teachers and experiences — things that these days might be called bullying or even harassment.

The recent tendency in medicine has been to soften the system a bit. The hours' cap has dramatically changed the face of residency and not always for the better. Along with more reasonable work hours, I’ve observed a lower level of felt personal responsibility — the resident's hours are up for the week, so he is signing out, whether or not that’s what’s best for the patient.

For that reason and others, I have to admit that when I read Dr. Sekeres’s article, my response wasn’t primarily agreement — it was concern. My concern is that as doctors, we have a duty to care for our patients at the highest levels of rigor. And the medical training — the long hours, the unreasonable standards, and the exacting mentors — supports that in many ways.

But the more I thought about it, there more I realized that while rigor is crucial, there is a difference between rigor and bullying. I even see it in my own medical teaching. While other surgeons were known for loud operating rooms — music and shouting and even throwing things — my OR was always quiet and calm. Similarly, my relationship with the medical students was always calm, precise, friendly, and even relaxed — we collaborated from a love of learning and a love of work done well. And they worked very hard. So even my own experience contradicts this idea that rigor goes hand-in-hand with bullying.

Especially in the medical landscape in which we find ourselves today, healthcare collaboration is deeply important, possibly the most important thing that can happen on any given case. The truth is that the time of the Lone Wolf Doctor is over, and so if the bully-them-until-they-shine approach was ever effective, it’s certainly not effective in an age when collaboration and coordination calls for teamwork, respect, and collegiality, all of which can be taught and modeled just like surgical techniques.

My takeaway? We benefit from rigor but we don’t benefit from our teachers pulling rank, creating an un-collaborative environment, or not valuing every member of the medical team. We don’t benefit from teaching new doctors that they are alone in their work, must solve every problem on their own, and can disrespect their colleagues when it suits them.

Yes, demanding high standards of care and work ethic alongside high standards of professionalism and collegiality is a very high bar. But our patients' lives require it, and I believe that each of us is up to the task.


For more stories of how doctors are doing healthcare collaboration, download our Quick Guide: 


ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, good medicine, healthcare collaboration

Can Telemedicine Yield Results of High Intensity Without the High Cost?

Posted by Lawrence Kerr on Thu, Jun 14, 2018 @ 06:00 AM

hush-naidoo-535092-unsplashIt's a simple but troublesome truth that, as The New York Times puts it, “How much you spend on medical care depends on what you get, but also where you get it.”

And in an age when the whole medical community is pushed to increase efficiency, this reality is challenging to providers and to hospital systems. How are we to cut costs and provide high-value and high-efficiency care when costs vary not only by the care provided, but by where it’s provided, and who pays for it?

Costs of the same operation or care can vary dramatically in different places. This is due to different prices (and costs), of course, but it also has to do with the "intensity" of care. 

If you deliver a baby in a teaching hospital, it costs $2,000 more (on average) than delivering at a community hospital. Part of that is because of the difference in prices, but part of it is because the "intensity" of care (number of providers, specialization of providers, services provided) is greater at the teaching hospital. 

As the healthcare system struggles to provide care that is high-value for patients and efficient for providers and hospital systems, it's hard to know whether and when high-intensity care is worthwhile and when it's just, well, expensive.

So a recent study of Medicare hospitalizations -- led by Laura Burke and Ashish Jha at Harvard -- is interesting. It analyzed about 11 million Medicare hospitalizations and found that almost all patients had lower mortality rates at teaching hospitals.

But, as the New York Time synthesizes, "Among patients admitted for operations like hip replacements, the patients with the most health problems over all were the ones likeliest to benefit from a teaching hospital. On the other hand, among people admitted with conditions like pneumonia or heart failure, though all groups did better at the teaching hospitals, the difference was greatest for the relatively healthy patients."  So, interestingly, the high intensity care lead to better outcomes overall, but there are situations in which the difference is not significant. 

This led us to wonder whether there are ways that community hospitals or individual providers could provide the advantages of teaching hospitals, but at a lower cost, and in their care setting. As the study shows, "The more advanced technologies available at teaching hospitals explained some, but not all, of the difference. Other factors like subspecialty expertise, more clinicians involved in care, and greater availability of ancillary services may also be playing a role.”

The importance of subspecialty expertise and the inclusion of more providers in care points to the potential of healthcare collaboration, especially where supported by a tool or technology like iClickCare. If a community hospital can loop in sub-specialists that are not based at that hospital (but on their schedule, asynchronously)... and if the tool supports team collaboration in a meaningful way... it raises the question whether telemedicine-based healthcare collaboration could provide the benefits of the intense care at teaching hospitals, but at a much lower cost. 

Of course, this will need to be studied on a large scale for conclusive results -- but anecdotal results from our colleagues indicate this does work. You can get the benefits of high-intensity care, but from a community hospital, at a lower cost.


Looking for a low-cost way to implement a telemedicine program? Download our Quick Guide to explore hybrid store-and-forward telemedicine:

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Tags: care coordination, healthcare collaboration software, cost effectiveness

Two Studies Show Care Coordination Can Be Simple

Posted by Lawrence Kerr on Wed, Jun 13, 2018 @ 06:00 AM

kara-michelle-544960-unsplashThere are certain transition points in medicine that are short in time, but outsized in importance. For instance, the moment of discharge, the moment of intake, the moment the patient arrives home after a hospital stay -- these are all brief periods within the scope of care but all have a big impact on outcomes.

And frequently, these moments of transition are attended by providers on the continuum of care that aren’t doctors and certainly aren’t super-specialists. It’s the aides, the nurses, the pharmacists, and the WOCNs that are there during these crucial moments.

Two recent studies put a spotlight on this truth for us… demonstrating just how important this dynamic is.
As Fierce Healthcare explores, “A nurse is typically the first person a patient interacts with, and he or she can set the tone for the entire visit.”  Because of that frontline position, a nurse can play a critical role in establishing a strong patient-provider, family-organization, relationship and even affecting the chances of a patient embarking on the indicated care plan. Nurses can also become a bridge among care modalities, connecting aspects of care, like behavioral care and physical care. A study they explored found that nurses were the crucial provider in a program that aimed to unify and streamline these two care approaches.

Similarly, Fierce Healthcare looked at an issue at Virginia Commonwealth University, in which pharmacists, a key part of the discharge process, weren’t being communicated with effectively: “Even though they are a key part of the discharge process, they had limited information on which patients were closest to being sent home.”

So Kelley Barry, senior clinical applications analyst at VCU Health, built a new system to indicate whether a pharmacist needs to rush to fill a prescription, whether a prescription is being waited for or delayed, or whether it’s been filled. Of course, “Discharge is a critical time for patients, particularly the elderly, and research shows that a more efficient, coordinated approach can ease the transition from hospital to home.”  VCU’s program lead said that the key step was breaking down the silos between the people involved in discharge.

"If you're not all working toward the same goal, you'll never meet it," Barry said. "If we all join in the conversation in real time, it makes things more efficient. That's what everybody really wants. How do we respect everyone's time and give the most updated information that everyone can act on?" 

In both cases — that of the study of the nurses and that of the pharmacist-oriented program, the solutions used:

  • Were simple and inexpensive.
  • Involved providers across the continuum of care.
  • Prioritized sharing information and bringing more people into the conversation.
  • Allowed participants to engage on their schedule, rather than a rigid way.
  • Didn't wait for change across the system -- they made improvements within an arena they could impact.

These are inspiring examples of people using care coordination, technology, and team-based healthcare collaboration in innovative ways. Did that innovation involve an expensive or technologically-advanced tool?  No. And that's just what makes these solutions so ingenious.


For more on simple ways of doing healthcare collaboration, get our Quick Guide for free: 

ClickCare Quick Guide to Medical Collaboration

Tags: care coordination, healthcare collaboration, nurse collaboration

Where Healthcare Collaboration, Telemedicine, and Patient Navigation Intersect

Posted by Lawrence Kerr on Thu, Jun 07, 2018 @ 06:00 AM

rawpixel-603653-unsplashOncology care is one area where care coordination, access to good care, and healthcare collaboration come to the fore.

The stakes are very high, the treatments are long-term and complex, care teams are interdisciplinary and cross the continuum of care, and there are often outcome disparities related to socioeconomic status. 

So I was really interested to review the proceedings of a workshop looking at Establishing Effective Patient Navigation Programs in Oncology, published by the National Academy of Sciences. The work raised some important questions about when patient navigation is effective, what problems it solves -- and what its crucial shortcomings are.

The context for the publishing of the proceedings of this workshop: The National Academy of Sciences, who published it, was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. In itself, it is a fascinating example of interdisciplinary collaboration.

The question explored in this workshop is whether, how, and under what circumstances, patient navigation can be a key tool for improving oncology outcomes. Of course, delivering high-quality cancer care to all patients presents numerous challenges, including difficulties with care coordination and access. The supposition is that "patient navigation" can be an important tool for meeting these challenges.

Patient navigation is defined in the paper as, "a community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to care.” (Freeman and Rodriguez, 2011). Navigation can improve early detection and screening, increase clinical trial enrollment, and remove barriers to care, etc.

How does that relate to healthcare collaboration?  In one way it is the same. The goals are the same, and the impetus for the development of the practice is the same. On the other hand, there are a few key differences. Patient navigation: 

  • It is disease-specific. Instead of looking at the whole patient across the continuum of care they need, the program focuses on cancer care.
  • It is centralized. Ultimately, patient navigation is a centralized hub approach. There is a central patient navigator, not team collaboration among all the parts of the team.
  • It doesn't change the fundamental care and collaboration patterns. Patient navigation is a bit of a stop-gap for a medical system that's working in sub-par ways, rather than a more fundamental transformative tool in how we do medicine in the first place.

Key unresolved questions of patient navigation are described: 

"Unresolved questions include where patient navigation programs should be deployed, and which patients should be prioritized to receive navigation services when resources are limited. Patient navigation systems are often implemented as an attempt to address socioeconomic disparities in care delivery. Therefore, many interventions have been clustered in pre-dominantly minority and economically underserved areas, often in urban cancer centers. However, navigation programs often go beyond poor and underserved patients, to aid all patients. Experts also continue to debate whether patient navigation should be proactive or reactive, and who benefits most from using navigation programs, particularly with regard to ongoing concerns about the cost and value of care."

The description of these unresolved questions brought to the fore one of my key concerns about the patient navigation model. Everyone, everywhere, deserves and should receive collaborative, connected care. In order for that to be a reality, however, that would mean that our workflows would be supportive of collaboration throughout medicine, not that we create workarounds to treat the consequences of care when it's not collaborative. Patient navigation requires an assigned navigator -- which is an expense -- rather than enabling more efficient and time-proven workflows that are enhanced by technology such as Hybrid Store-and-Forward Telemedicine.

On one hand, this kind of patient navigation initiative is deeply impressive. Healthcare is facing so many challenges that if we don't have some "stop gap" programs patients will certainly be suffering needlessly. But so many parts of this feel like band-aids. The patient navigation itself is a bit of a band-aid for a system that isn't enabling its healthcare providers to collaborate. And then even the tools that patient navigation programs are encouraged to employ -- like videoconferencing -- to oversee navigation, are not as helpful as transforming workflows and enable true team collaboration. 

Ultimately, I'm firmly in support of this kind of program. I'm also in support of programs that seek to shift the structures, workflows, and systems whose limitations create the need for this kind of program in the first place. 


For more on Hybrid Store-and-Forward telemedicine, download our free guide here:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, care coordination, healthcare collaboration

Store and Forward Tele-Psychiatry Contributes to Healthcare Collaboration

Posted by Lawrence Kerr on Thu, May 31, 2018 @ 06:00 AM

markus-spiske-187777-unsplash (1)These days, we have a culture of "now is better."

The faster the food delivery comes, the faster the Amazon box arrives, the faster the doctor calls back -- the better.

So, many people fall into the trap of believing that live videoconferencing is the preferred form of telemedicine. If "now is better," a live videoconference with a colleague or your provider is best.

The truth is that hybrid store-and-forward telemedicine has been found to have profound advantages over videoconferencing telemedicine models. And it may not be for the reasons you think.

An interesting model of “integrated behavioral healthcare” is advancing some interesting findings around the divide between asynchronous models and videoconferencing models. A study published recently looks at a program in which a team of primary care providers (PCPs) and behavioral health providers, work together in the primary care setting. The intention is to explore whether, for psychiatric use, it's helpful or necessary to have synchronous communication (like videoconferencing.) Half of participants are randomly assigned to an asynchronous model of consultation while the other half are assigned to a videoconferencing model. 

Initial summary data and case findings of a 5-year study of a randomized controlled trial of an asynchronous model compared with a videoconferencing model seems to be indicating that the asynchronous model works equally well, but with less cost and lower administrative burden.

Live videoconferencing is effective, but can be augmented and sometimes replaced by the more efficient, less costly, and more time respectful Store and Forward.

As the study authors summarize, "When PCPs are able to combine direct care with synchronous and asynchronous consultation options, a multitude of care possibilities become available, enabling a more flexible and stepped care structure.”

The study acknowledges that not only is asynchronous care less challenging logistically, but it is also a much more data-rich method than synchronous (like videoconferencing) approaches.

I think this is an exciting contribution to our field's ongoing exploration of the best role for telemedicine in the healthcare system. As we discussed in yesterday's post, the healthcare field will deeply benefit from breaking down the preconceptions of what telemedicine can look like, and what the benefits really are of on-demand communication. It's our responsibility to think creatively about what programs can look like, take a holistic view of effects and costs, and be thoughtful about what the best technology for support.


Download our free white paper on the pros and cons of hybrid store-and-forward telemedicine:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: Store and forward psychiatry

Healthcare in a Barbershop is Better than Healthcare in a Doctor's Office

Posted by Lawrence Kerr on Wed, May 30, 2018 @ 06:00 AM

edgar-chaparro-565268-unsplashTelemedicine is a technology with almost unlimited applications — most of which healthcare hasn’t even thought of yet.

Currently, however, telemedicine is primarily applied in pretty narrow ways. Commonly, telemedicine is used for provider-to-provider communication within the usual structure of visits. Or, it is used to allow far-flung patients to approximate a usual visit, but at a distance.

A new study turns a lot of this on its head, bringing into question our ideas about where healthcare need take place, and under what conditions.

A recent study, published in the New England Journal of Medicine, looked at the ways that it’s not just the treatment or the information that matter — it’s also where that treatment comes from, and from whom. In the study, a cluster-randomized trial, black men got blood pressure intervention in two different ways. The control group had their blood pressure measured in a barber shop, but were then referred to a physician for management. The intervention group received treatment in the barbershop itself.

More than 63 percent of the intervention group achieved a normal blood pressure level after 6 months, compared with less than 12 percent of the control group.

Dr. Aaron E. Carroll wrote a great piece on the study in the New York Times recently. As he summarizes, “Health care need not take place in a doctor’s office — or be provided by a physician — to be effective.”

In fact, Carroll argues that this approach was dramatically more effective than it would have been had it been a more traditional, hospital-centered approach. He identifies a few key factors that made this intervention such a success. The care was: 

  • From a trusted source.
  • Low inconvenience.
  • Integrated with peer support.

Dr. Carroll does point out that there are reasons that this kind of approach isn't common, however. “Health care reimbursement in the United States usually focuses on the clinical encounter, at a physician office or hospital. This reflects a belief that care is best offered there, even when evidence says otherwise. Coverage and payment focus on the individual patient, not on the community, even when research shows that the latter is more effective.”

This analysis really resonated with us as well. Telemedicine has the profound potential to support care that is from a trusted source, low inconvenience, and integrated with peer support. It has the potential to enable care that is deeply embedded into the communities, culture, and lives of the patients we serve, allowing the most advanced care, but in nontraditional settings, and with nontraditional providers as core parts of the care. Because ultimately, we don't have a failure of technology to support it -- we have a failure of imagination for what these initiatives can look like. And, as Dr. Carroll says, we have a failure of the reimbursement and payment systems. 

This powerful study is proof positive, though, that we don't have to wait for the whole healthcare system to change in order for brilliant things to happen. A simple initiative, caring participants, and thoughtful, respectful design -- these are the things that enable change to happen.


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Tags: telemedicine solutions, telemedicine reimbursement

The Royal Wedding and Healthcare Collaboration

Posted by Lawrence Kerr on Tue, May 22, 2018 @ 06:00 AM

marko-pekic-145777-unsplashOne of challenges, and frankly, frustrations, of what we do at ClickCare is communicating the value of collaboration. The rewards (both emotional and tangible) to providers, patients, and institutions, are profound and meaningful. But to the uninitiated, healthcare collaboration can seem idealistic and impractical.

Collaboration is given lip service (Chronic Care Management CPT code XXXXX) but not truly cultivated or supported. It is not taught in medical schools, as there is such a competition for time in a curriculum. It seems to be taught better in nursing schools, but the experienced nurses are known for “eating their own”.  Pharmacy schools rarely produce graduates with a true intent on fitting into a team, and when they do, it's despite their training, not because of it.

Because of this conventional bias against healthcare collaboration, it takes true leaders (whether those leaders are aides or specialists or nurses or patients) to foment it. True leadership doesn't have to be sanctioned by an institution or lauded in a newspaper -- sometimes it's just simple acts of asking a question of a colleague or taking a moment to try something new. But true leadership does tend to take courage -- and it can give us courage to see other leaders, acting bravely.

So, when I find an example of leadership, I feel it should be acknowledged, celebrated, and learned from -- even if from an unlikely source.

I'll be honest -- I wasn't planning to wake up early to watch the royal wedding. Like many Americans, I often feel conflicted about the Royals -- and (not being very interested in fashion) wouldn't expect to find much of significance in such a seemingly frivolous event. 

But I ended up watching it from start to finish, finding myself drawn into the tradition, the ceremony, and the powerful lessons of both collaboration and leadership that made themselves known in subtle, but deeply significant, ways. 

A few leadership and healthcare collaboration lessons I learned from watching the royal wedding:

  1. Lead by inclusion and by example. 
    The bride and groom chose to include an American Episcopalian pastor in the African American tradition to give a sermon, something that had never been done before. They included an African American choir singing Stand By Me and Amen, Amen alongside the traditional songs. Instead of demurely hiding Meghan's African American heritage, they wove it artfully into the ceremony. And although surely not all of the tradition-bound attendees were fully supportive, the bride and groom were grounded and joyful throughout the event, not scurrying around for approval, but standing firm in the choices they made to honor tradition, honor both of their heritages, and perhaps bring the monarchy into a new age. This seemed to me an example of the best kind of leadership by example, not by rhetoric or coercion.

  2. Don't be afraid of the big issues.
    By acknowledging Meghan's heritage and country of origin throughout the event, the royal couple certainly took on the "elephant in the room," which could be an element of contention for such a tradition-bound event and context. Similarly, the beautiful sermon by Bishop Michael Curry made unflinching reference to the history of race relations in the US, including the Civil Rights Movement and slavery. Throughout, there was a willingness to take on what might be considered "difficult" or fraught topics, but to do so in elevated, inclusive ways.

  3. Remember that nothing big happens without collaboration.
    Yes, Saturday's event was a wedding. But it was also a massive event involving thousands of people, viewed by millions, and costing close to $50 million. It's staggering to imagine the massive collaboration that must have been needed -- to have each person contribute and be truly honored as important, but also have their contribution blended to become the whole. From the Kensington gardener who nurtured the flowers that Harry chose for Meghan's bouquet, to each musician that shared their song, to the members of their families, to the bride and groom themselves. Just the existence of such a scale of event is testament to the power of collaboration.

  4. Love is all you need.
    It seems sentimental and perhaps even unprofessional to speak of love in a blog post for a telemedicine company. But Bishop Curry's sermon reminded us of the transformative power of love in the creation or recreation of a culture, society, and world. He reminded us, as the royal wedding did, that love can be a catalyst for profound change and the driver of things that would be unimaginable without love's transformative power. Maybe in medicine we should talk more about love. And leave the medical jargon behind.


Will this event actually be remembered and change something, as the new couple wishes? Maybe or maybe not. But I do believe that in its example, this event gave us a shining example of a way forward. We need to respect each other; we need to find a greater cause in our duty; we need to compromise; and we need to be steadfast in our choices.

Many felt joy in watching the royal wedding on Saturday. And I believe that joy is something each of us can access daily (even hourly) in our everyday choices about leadership and about collaboration.



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Tags: good medicine, healthcare collaboration

Why Intensive Programs Can Save Money Long Term

Posted by Lawrence Kerr on Thu, May 17, 2018 @ 06:02 AM

nick-hillier-328372-unsplashSometimes it is said that one needs to "slow down in order to speed up" -- meaning that the things that take time now can often save us time later. 

UnitedHealthcare's HouseCalls program, which recently surpassed 5 million visits, seems like just that kind of "slow down to speed up" situation. You wouldn't think that the program -- which brings healthcare to people's homes with house calls -- would be any kind of revenue generator or money saving initiative. But the results have been surprising.The program brings healthcare providers into peoples' homes, primarily for checkups and preventative care. For Paul Engwall, the visit by Hesper Nowatzki, a nurse practitioner, was life-saving. A simple urine dipstick done during Nowatzki's home visit, revealed kidney disease, which has since been treated. 

As Fierce Healthcare reports, "The program was solidified six years ago with the purchase of XLHealth, a Medicare Advantage plan that focused on beneficiaries with chronic conditions that were also eligible for Medicaid. At the time, UnitedHealth predicted it would add about $2 billion in revenues." 

The program tends to cut hospitalizations and high-cost admissions. "Practitioners typically spend 45 to 60 minutes with each member, often addressing issues that a primary care physician can’t, such as access to food and transportation that may be inhibiting access to care." 

This program may not win any awards for most cutting-edge technology, but the care and savings are exemplary. To us, it's a great example of a simple program that questions what we think are the most cost-effective ways to provide care, in order to prioritize care that is truly helpful for our patients.

Of course, we happen to think the program would be even more powerful if nurse practitioners like Hesper Nowatzki had the capability of collaborating with other providers (like specialists). How much better if any little "red flag" didn't mean the patient immediately needing to jump in the car, but could rather be additionally helped by a remote team. But for now, programs like these are certainly steps forward -- they question the things that we think will save money and prioritize the things that will really improve care.


Hear stories of how telemedicine programs are cutting costs and improving care: 

ClickCare Quick Guide to Telemedicine

Tags: telemedicine technology, telehealth and hipaa

Collaboration and Stories Might Be What Makes Humans Unique

Posted by Lawrence Kerr on Tue, May 15, 2018 @ 06:00 AM

bernard-hermant-665070-unsplashI’ve been meaning to read the book Sapiens for a while now. Billed as a “brief history of mankind,” the book looks at 70,000 years of history and science to explore what makes us human.

Recently, though, a friend summarized the book's main conclusion and theme — and his summary stopped me in my tracks.

There are a lot of learning from the book, he said, but “Overall, the most important is that it is collaboration and stories that make humans different from animals — collaboration and stories.”  Collaboration and stories -- two things that seem so optional, so subtle -- could these really be the things that make us unique, make us powerful, and make us tick?

The book’s author, Yuval Noah Harari, was interviewed by Smithsonian recently, and elaborated on each topic as follows…

On how humans use stories:

“The truly unique trait of Sapiens is our ability to create and believe fiction. All other animals use their communication system to describe reality. We use our communication system to create new realities.”

On how humans cooperate and collaborate:

“The Sapiens secret of success is large-scale flexible cooperation. This has made us masters of the world. But at the same time it has made us dependent for our very survival on vast networks of cooperation.”


These insights are important for medicine, as well. It’s so easy for all of our institutions, technology, and systems to strip away what is most human about us. It’s easy for our medical practice to become very literally “dehumanized and dehumanizing” in our pursuit of efficiency -- we literally cut out collaboration and stories in order to save time and money.

When we are forced to rush through visits, we miss the stories that make the patient who she is. When the only collaboration tool we have is uni-directional text messaging, our ability to collaborate and cooperate in complex ways is limited.

That’s why I believe that initiatives that re-embed medical care back into our personal contexts, that allow us to connect with each other in rich ways, are those that end up being most effective and most powerful. Ironically, sometimes these initiatives are almost laughably simple. For instance, Cleveland Clinic is creating a "groundbreaking initiative" affecting 50,000 providers -- which amounts to little more than a reminder to remember patients' stories and to have empathy. Certainly this is backed up by the Sapiens author, but not very surprising for most good healthcare providers. (Of course, trying to systematize something like empathy can backfire in unintended ways, but here I'm just highlighting the interesting nature of the initiative existing at all.)

It's certainly why iClickCare is intuitive to use, allows rich and complex sharing (pictures, long form narrative, and videos) in consultations, and supports multi-directional, complex collaboration. 

In some ways, what's most groundbreaking in medicine is actually that which brings us back to our core as people -- and that's always been pretty simple. 

Learn more about how hybrid store-and-forward allows for rich, simple collaboration: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, hippa secure healthcare collaboration

When It Comes to Telemedicine, People Matter More Than Tech

Posted by Lawrence Kerr on Thu, May 03, 2018 @ 06:00 AM

charles-deluvio-456508-unsplashIt sounds idealistic to say that people matter more than money or technology.

But when it comes to insurance companies, they tend to be far from idealistic and very clear on their profit motive. So we stopped and took notice recently when their actions seemed to show that even they think that when it comes to healthcare, doctors matter more than many other factors.

Fierce Healthcare reports that insurance companies are increasingly buying physician practices, rather than large hospital systems or other entities.

And the characteristics they are looking for in those practices is illuminating. It's not necessarily hard assets, proprietary tech, or other "rock-star" qualities. According to Fierce Healthcare, in the practices that insurers are buying, the commonalities seem to be that the practices are:

  • Physician-led.
    Cost-control and quality improvement are more likely to happen when practitioners themselves have a stake in the outcome. 

  • Strong in primary care.
    Primary care is the entry point for most patients and it's where practitioners are focused on the whole patient, not just one condition. 

  • Diversified.
    Covering enough specialties to provide a broad spectrum of patient care is important for patient retention and satisfaction.

  • Wired.
    A medical group must have up-to-date technology to collect and analyze patient data. Higher quality outcomes and lower costs come hand in hand when better data and information are available. 


Insurers, of course, aren’t acting altruistically. They know that by focusing on these dimensions, their ability to control costs and increase profits are far greater. In other words -- putting people, especially providers, at the center, is smart business. 

We've found the same in all of our work in telemedicine. Despite the common desire to invest in expensive hardware, it's actually great training, good support, and smart workflow that support the strongest telemedicine programs. In other words -- making things people-centered makes things work better. 

Learn more about how hybrid store-and-forward telemedicine puts healthcare providers first, and tech second: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, telemedicine and hippa

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